CT features of pneumonia during COVID-19 pandemic warrant caution: An illustrative case report of cholangiocarcinoma with Pneumocystis jiroveci pneumonia

Background: An outbreak of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection (COVID-19) that began at Wuhan, China in December 2019, spreading rapidly across China and many other countries. Considering the high false-negative rate of RT-PCR assay during initial COVID-19 pandemic in China, chest computed tomography (CT) was advocated as a means of corroborating clinically suspected infections. Case presentation A 51-year-old man with clinical diagnosis of hepatic portal cholangiocarcinoma and Behcet's disease developed clinical manifestations suggestive of COVID-19 during the pandemic in China. The chest CT showed rapid progression to diffuse ground-glass opacities (GCOs) in both lungs, as in severe cases of confirmed COVID-19. He was finally diagnosed with Pneumocystis jiroveci pneumonia (PJP) according to the medical history, and Caspofungin plus TMP/SMX elicited a rapid response as normalizing both temperature and leukocyte count initially. Unfortunately, dyspnea was aggravated with resumed fever later, and non-invasive ventilation was no longer tenable. The patient himself (with support of his family) declined mechanical ventilatory assistance, succumbing to pneumonia and respiratory failure finally. Conclusions: CT diagnosis of COVID-19 during the current pandemic should warrant caution.